First described in 1980, percutaneous gastrostomy is now established as a safe and
useful means of providing enteral nutrition. The working lifespan of a gastrostomy
varies from weeks to many months and a significant proportion of patients will require
replacement of the tube at least once, and occasionally several times [1]
[2].
Replacement of the tube is technically simple in most patients, involving the introduction
of a new, lubricated tube through the existing stoma. However, we have found it difficult
to replace tubes in some patients for one or more of the following reasons: a) narrowing
of the tract, either due to fibrosis or to voluntary muscle spasm in apprehensive
patients; b) the oblique course of some tracts; and c) the relative flexibility of
the tubes, which leads to bending of the tube instead of forward movement into the
tract when force is applied (Figure [1]).
Figure 1 A gastrostomy tube on its own is quite flexible.
We found that by reinforcing the soft tube we could carry out replacement in all these
situations. The reinforcement technique consists of passing an endoscopic biopsy forceps
through the tube, making sure that the tip of the forceps reaches at least to the
tip of the gastrostomy tube (Figure [2]). The forceps may protrude just outside the tip of the gastrostomy tube, but this
is not essential. The forceps affords just enough firmness, while retaining some flexibility,
to facilitate insertion of the tube without creating false tracts. After the tube
has been advanced into the stomach to a satisfactory extent, the biopsy forceps is
removed and the gastrostomy tube is fixed.
Figure 2 Reinforcement of a gastrostomy tube with an endoscopic biopsy forceps makes it more
rigid.
Passing the tube over a guide wire or freezing of the gastrostomy tube in order to
stiffen it are other alternatives, but we find that the biopsy forceps stylet technique
is by far the simplest and most successful method.
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